STRATEGIC PLAN 2011‐2015 potx

The two overall strategic objectives for health in the Roadmap are as follows: The major public health concerns are non‐communicable diseases, emerging and re‐emerging communicable di

2011‐2015

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MESSAGE FROM THE MINISTER FOR HEALTH………  3 

    FOREWORD FROM THE PERMANENT SECRETARY FOR HEALTH……   4 

  INTRODUCTION………  5 

GUIDING PRINCIPLES………  6 

Mission    Vision        

Values        

     FIJI AND ITS PEOPLE………   7 

HEALTH IN FIJI        

   Health Indicators……….   8  

Specific Diseases and Health Programmes………   9 

Clinical Services……….   9 

Human Resource Development……….   10 

Infrastructure………    10 

Health Service Structure………    11 

Health Care Budget………     11 

Health Care Financing Options………    12 

THE PLANNING CYCLE……….  13 

STRATEGIC GOALS, OUTCOMES & OBJECTIVES, 2011/15………   14 – 23   

STRATEGIC PLAN WORKSHOP PARTICIPANTS LIST………    24 ‐ 25 

The  Strategic  Plan  has  been  developed  in  concert  with  the  Government’s  national  strategic  policy  document: the 2009 – 2014 Roadmap for Democracy and Sustainable Socio‐Economic Development.  The two overall strategic objectives for health in the Roadmap are as follows: 

The  major  public  health  concerns  are  non‐communicable  diseases,  emerging  and  re‐emerging  communicable diseases, maternal and child health, mental health and pandemics or other disasters  affecting the  health and well‐being of the community. There are  other environmental factors that  have an impact on health such as climate change and these need appropriate consideration as well.   

A  major  focus  is  to  operationalise  programs  at  grass  root  level  in  the  areas  covering  MDG  4‐5‐6.  Likewise, serious operational programs to control communicable diseases will be addressed. 

The arena of NCD needs to be tackled by over arching Health Promotion in its entity with seedling  strategies  to  address  diabetes,  hypertension,  cardiovascular  diseases  and  cancer  from  within  the  sphere.  Greater  emphasis  on  wellness  rather  than  treatment  must  evolve  with  High  impact,  Low  technology innovations. 

A focus on human resource development and staff retention will still be maintained and addressed 

in depth to meet the acute shortage of health professionals; as this is vital to ensure sustainability in  the delivery of health services to our people. Increased on‐going education locally and abroad will  need  to  be  saddled  with  career  orientation  for  our  young  workforce  to  improve  on  retention  strategies. 

Customer focus remains areas of major concern in 2011 – 2014; increased output from the medical  and nursing schools will address some of the work pressure. 

I therefore invite all of our partners in health; NGO’s, donor agencies, other ministries/departments  and  the  private  sector  to  work  closely  with  the  Ministry  of  Health  towards  achieving  the  two  strategic objectives cited above.    

At  this  point,  I  must  sincerely  thank  all  those  that  participated  in  the  formulation  of  the  Strategic 

Plan  2011‐2015  for  Proverbs  24:6,  “For  waging  war  you  need  guidance,  and  for  victory  many 

advisors” is appropriate in this case. We recognise this spiritual truth in that there is a key role other 

stakeholders play in our efforts to winning this war against infirmity, sickness and disease.           

I  acknowledge  that  while  the  challenge  before  us  is  immense  I  am  fully  pursuaded  that  by  God’s 

It is worth emphasising here that, in a Strategic Plan, the “targets” mentioned above are not deliverables as such; they are situations to “aim” at, not necessarily results to achieve It is the Ministry's Annual Corporate and, within the Ministry's operations the Divisional and other sectional Business Plans, that contain particular key results which are there to be actually achieved and delivered in the year

The Ministry also took into consideration the Millenium Development Goals [MDG’s] and it is also worth noting that while there are three MDG’s directly related to health [MDG’s 4, 5 & 6] there are also two other MDG’s that have health related components, which are MDG’s 1 & 7

This Strategic Plan has seen it fit to include a third Strategic Goal (Outcome) to capture those objectives that, even though they relate indirectly to the seven Health Outcomes, are of equal importance in providing relevance to the Ministry’s strategic plan

Many of the strategic objectives will require partnerships with and the collaboration of other organisations including non‐government organisations, donors and other government departments These partnerships and the collaborations are all very important and it has been therefore very encouraging, during the process of developing this strategic plan to have had input from many of those partners and collaborators, including their participation at the 2011/15 Strategic Plan Workshop held on 11th and

12th August of 2010

This Strategic Plan establishes and confirms the strategic intent that it is Primary Health Care, including Preventive Health, that should be the first and principal focus of the Ministry over the next five years, in addressing the health and wellbeing of the citizens of Fiji Clinical services will be also further invested in, developed, improved and strengthened through the implementation of the Ministry's clinical health services planning, in order to meet the health care needs of the population

The 2007 census placed Fiji’s population at 837,271 (for government planning purposes these are divided into four divisions; Central ‐ with a population of 342,477, Eastern ‐ with a population of 39,313, Northern ‐ with a population of 135,961 and Western ‐ with a population of 319,611) The total rural population was 412,425 or 49.3% of the national population with total urban population at 424,846 – 50.7% of the national population.1 The trend reveals a growing urban drift in Fiji’s population

Overall, the progress towards achieving the MDGs in Fiji is progressing on incremental basis; however, they are not sufficient enough to meet the targets by the year 2015 In the area of Health related MDGs 4, 5 and 6, Fiji is facing major challenges in achieving key targets Some of the contributing factors include staff shortages, insufficient monitoring of pregnancy related illness, cost of health services to allow poor to take advantage of available health facilities and the need to strengthen health system through improving investment in technical infrastructures2

The indicators for MDG 4 show that infant mortality rate has declined by about 23% over the past 20 years but it would need to decrease by a further 57% over the next 5 years3 The major causes of mortalities include perinatal conditions such as birth asphyxia, congenital malformations, sepsis, under‐weight and congenital syphillis2

Likewise, achieving the targets of MDG 5 needs to be addressed comprehensively While proportion of deliveries by skilled health personnel has been fairly high throughout the 1990 to 2008 period and the maternal mortality ratio declined by 23%, this would need to decrease by a further 68% to meet the target3 There is also lack of data on adolescent birth rate and unmet need for family planning for most years.4 The contraceptive prevalence rate has also remained low between 35% and 49% from 2000

TB has declined over the years

Whilst there has been a decline in the incidence of some of the communicable diseases over the past 20 years such as tuberculosis and filariasis, the rise in incidence of Leptospirosis and typhoid fever in recent years is a cause for concern The growing burden of non‐communicable diseases is demonstrated by the NCD STEPS Survey of

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2002 which reported a prevalence rate of Diabetes at 16% and Hypertension as 19.1% The report also highlighted that a third of all deaths were due to circulatory diseases.5 6

An assessment of Fiji’s progress towards achieving its health outcomes depends on a well functioning health information system with access to age, sex and geographical, time series disaggregated data, some of which were not available Efforts are being made to address the data gaps to enable planning for prevention and response to emerging health issues

The threat of emerging and re‐emerging communicable diseases, like TB, SARS, and avian influenza (HPAI H5N1), that pose international threats and would have socioeconomic impacts on Fiji has highlighted the need for vigilance in surveillance, border control, detection capacity, investigation capacity and capacity to respond in a timely and coordinated manner

Demand on outpatient hospital services has been such that it has led to an uneven load with generally over‐utilised resources at the divisional hospitals at the expense of urban and peri‐urban health centres A strategy to counter this trend has been to extend opening hours at selected health centres, which has seen improved results in reduced waiting times

Hospital care of patients have changed in the last decades because of the increases in admissions and the occupancy rates, especially in the 3 divisional hospitals, with resultant increases in the average length of stay [ALOS]

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The Ministry of Health has developed a Clinical Services Plan, which provides the framework in which to strengthen its clinical services at all levels of care Part of this initiative has seen the formation of Clinical Service Networks [CSN’s] of the various disciplines – Obstetrics & Gynaecology, Paediatrics, Surgery/Orthopaedics, Anaesthesia/ICU, Internal Medicine, Oral Health, Ophthalmology and Mental Health, Public Health, Radiology, Pathology Laboratory and Oncology

Introduction of new services include Cath lab services at CWMH, introduction of CT scan services at Lautoka and Labasa hospitals, while the new Eye Clinic at CWMH see an expanded ophthalmology service in operation

The Laboratory Information System [LIS] is scheduled to be set up in 2011 and will add

a new dimension to PATIS, something which has been long overdue Consequently this will, no doubt, improve clinical services

Staff retention is a major challenge for the Ministry of Health and it is committed to see that capacity building is implemented across all levels to ensure skills level are maintained at an acceptable level that will enable it to continue to provide quality healthcare services to the people of Fiji

As part of a concerted effort, the Ministry has looked to increasing its intake of trainee doctors and nurses while revising bonding conditions and introducing annual registration of health professionals and compulsory continued medical education

On this note, it is important to record that medical education in Fiji reached a new chapter in its history through the opening of a private nursing school in Labasa in 2005

A medical school was opened at the University of Fiji in 2008 and more recently Govt reforms led to the Fiji School of Nursing and the Fiji School of Medicine merging to become the College of Health Sciences under the newly formed Fiji National University

in 2009

The expected graduates from these institutions in the next several years should see an influx that for the first time in two decades could well be beneficial to the country

Infrastructure

The Ministry of Health has endorsed the Safe Hospitals concept in light of the exposure

of health facilities to natural disasters The concept looks at ensuring that appropriate facilities are available to enable safe delivery of health services to the communities At the same time, in terms of disaster preparedness, the Ministry has developed a National Disaster Management Plan for the purpose of effective and efficient resource utilisation

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There are plans to construct new hospitals in Navua, Ba and Nausori while the establishment of a regional mental health institution has already been endorsed by Cabinet and funding arrangements are being looked at

These major capital projects, together with plans for the introduction of new services in the divisional hospitals based on the Clinical Services Plan, will mean new infrastructure and facility developments taking place in the next several years

Government budget allocation for health has remained relatively constant despite the increasing demand and cost for healthcare In general Government has allocated a proportion varied between 9 to 11% of its total yearly public expenditures on health care

Total government health expenditure since 1995 remains between 2.5% to 3.5% of gross domestic product (GDP) Fiji has one of the lowest rates relative to other pacific island countries (PICs) despite being more economically developed For the last decade Government expenditure on health to date has never exceeded 4% of GDP

Health Care Financing Options

Government has recognised the need to strengthen healthcare services and through the Peoples Charter has made a commitment to have an annual increase to the health budget by 0.5% for the next 5 – 7 years to see it arrive to at least 5% of GDP; a figure that many observers say would make a huge impact on the delivery of healthcare services in Fiji

Other strategies have been introduced and include the introduction of mortuary fees, which has seen a positive result in that there is now no longer any complaints in relation to lack of space in mortuary facilities throughout public hospitals in the country

There has also been a focus on cost recovery strategies and a new schedule of fees for diagnostic and dental services and also inpatient hospital charges for paying patients are now in force However, it needs to be pointed out that all revenue collected from this exercise goes to General Consolidated Account

The establishment of a Health Care Financing Unit is part of the Ministry’s strategic

efforts to ensure it is able to identify gaps in the system and how to address them and also find out ways to have cost effective programmes

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The Ministry of Health is very keen on creating fiscal space to enable it to achieve its strategic objectives In this case, it is looking at a Mid‐Year Term Expenditure

Business Plans

Business Plans

PERFORMANCE

INDICATORS

ACHIEVED OR

UNACHIEVED

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STRATEGIC GOALS, OUTCOMES & OBJECTIVES

It is important that all of the strategic goals and objectives in this plan are understood

to be the outcomes, or impacts, that are desired over this five year period These are therefore described in outcome terms; that is as situations or states of being that are being aimed for Although there is some discussion in this plan of the methodologies which may be used to move towards the targets the objectives themselves are not activities or processes, they are the required and desired end‐states

Although all goals and objectives are impacts or outcomes, the Ministry of Health, some time ago, agreed the 7 Health Outcomes that it would focus on These are in the nature

of areas of or groupings of objectives Consequently all of the strategic objectives contained in this plan are, wherever possible, grouped under those stated 7 Health Outcomes The third strategic goal on strengthening the health system provides objectives, which contribute variously to the 7 health outcomes